Provider Demographics
NPI:1396406435
Name:RANDY JOTEN D.C. S.C.
Entity Type:Organization
Organization Name:RANDY JOTEN D.C. S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-299-0522
Mailing Address - Street 1:916 HAMMOND AVE
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-1770
Mailing Address - Country:US
Mailing Address - Phone:171-539-2247
Mailing Address - Fax:
Practice Address - Street 1:916 HAMMOND AVE
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-1770
Practice Address - Country:US
Practice Address - Phone:715-392-2476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty